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Organization

EAGLE RIVER THERAPEUTIC MASSAGE LLC

Active
Other names
ERTM Eagle River Therapeutic Massage
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JEANETTE STACK LMP, NCTMB (OWNER/MEMBER)
(907) 351-7191
Entity
Organization

Contact information

Practice address
10421 VFW RD, SUITE 101, EAGLE RIVER, AK 99577-8032
(907) 351-7191
(907) 622-4001
Mailing address
24712 TEAL LOOP, CHUGIAK, AK 99567-5114
(907) 351-7191
(907) 622-4001

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00014238
WA

Other

Enumeration date
06/14/2011
Last updated
06/14/2011
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